外伤后细菌性致死性肉芽肿感染动物模型的构建

目的：构建外伤后细菌性致死性肉芽肿(FBGT)的感染动物模型，以期为研究该疾病的发病机制及临床诊治建立实验动物学基础。方法：家兔40只，随机分为2组，每组分4小组，每小组5只，第一组每只给予泼尼松5mg／d灌胃制造免疫抑制状态，第二组作为正常免疫状态对照，每只家兔分别皮内多点注射痤疮丙酸杆菌(P．acnes)标准株悬液或本病患者皮损内培养出的FBGT致病菌悬液，同时皮内注射^60Co照射24h后细菌悬液作为对照。取注射部位的斑块及脑组织行组织病理检查、电镜检查及严格厌氧菌培养，分离传代后进行鉴定。结果：注射细菌部位出现斑块，部分皮损内有多核巨细胞聚集；脑组织病理检查发现淋巴细胞浸润；电镜发现脑组织中性粒细胞内有被吞噬的细菌。皮损内分离培养出的细菌经API鉴定为P．acnes，药敏试验与临床资料完全吻合。结论：外伤后细菌性致死性肉芽肿感染动物模型构建成功，为进一步研究其发病机制及诊治建立了可靠的实验动物学基础。     

外伤后细菌性致死性肉芽肿——一种新的疾病？

近20余年在我国多个地区发现一种外伤后皮肤肉芽肿,所发现的20余例有以下特点：（1）面,额部轻微外伤史;（2）皮肤进行性暗红色斑块,不溃破;（3）可在皮损附近或远处出现新的斑块;（4）病理示组织细胞肉芽肿;（5）后期出现意识障碍,剧烈头痛,但无明显的脑膜刺激征;（6）全部病人在1．5－4年内死亡;（7）糖皮质激素可使皮损暂时好转,但显著加速死亡。（8）患者均来自农村。最近通过透射电 镜等肯定了1例皮损内存在至少两种细菌,结合以往发现的3例予以报道,鉴于该病凶险,在反映疾病特征的命名中加上“致死性”以期得到重视。     

外伤后细菌性致死性肉芽肿4例再探讨

目的：再探讨外伤后细菌性致死性肉芽肿。方法：回顾性分析4例外伤后细菌性致死性肉芽肿的临床诊治过程,根据抗生素治疗中患者皮损、颅脑磁共振成像变化及最终结果,总结该病的治疗近况,提出抢救治疗的措施。结果：从3例患者皮损中成功分离出相同的严格厌氧性多形态杆菌,根据药敏试验结果选用敏感抗生素治疗,对皮损有明显效果,但颅脑损害尤改善,最终,1例无颅脑损害的患者治愈,3例伴颅脑损害的患者死亡。结论：外伤后细菌性致死性肉芽肿的治疗相当棘手,对于尚未累及颅脑的感染,林可霉素联合多西环素可作为首选。若已有颅内感染,除应用抗生素外,需积极考虑外科手术以期挽救患者生命。     

产于“外伤后细菌性致死性肉芽肿”一种新疾病的质疑

最近 ,包括一份医学专业性报纸在内的 2 0余家媒体 ,不断出现一个重复率很高的信息———“中国医生发现了一种新病”。我们查阅相关专业期刊和报纸 ,尚未发现与此相关的专家委员会发布的关于此病的声明或调查研究报告。也就是说将其作为一种新的疾病尚没有得到专家委员会的论证和认可。而此时在媒体上广为宣传有悖于科学准则。我们对其中一些专业问题的认识不敢与“外伤后细菌性致死性肉芽肿———一种新的疾病 ?”[1] 作者苟同 ,谨以此与高天文博士商榷。据对该病的描述 (见《中国皮肤性病学杂志》2 0 0 1年第 15卷第 1期 5 6页争鸣园地 )…     

外伤后细菌性致死性肉芽肿1例

目的:报道1例外伤后细菌性致死性肉芽肿患者。方法:分析患者发病过程及诊治经过。结果:患者外伤后出现面部进行性红色斑块,先行全身抗结核治疗无效。口服糖皮质激素治疗1个月后患者皮疹明显改善,随即给予皮损内糖皮质激素注射治疗,1周后患者出现发热和意识障碍,结合皮肤病理活检及头部MRI诊断为外伤后细菌性致死性肉芽肿。结论:外伤后细菌性致死性肉芽肿是一种感染性疾病。     

外伤后细菌性致死性肉芽肿复发后病原体药敏试验及形成生物膜的能力

目的:检测外伤后细菌性致死性肉芽肿复发后分离菌株对常用抗生素的最小抑菌浓度(MIC)和最小杀菌浓度(MBC)及其形成生物膜(biofilm,BF)的能力。方法:肉汤稀释法测定两次复发后分离培养的痤疮丙酸杆菌标准株(NCTC737)的MIC及MBC,XTT法测定BF形成的能力。结果:第二次复发后病原体林可霉素的MIC升高两个浓度级;该患者第二次病原菌形成BF的能力强于初次复发的病原体。结论:长期抗生素治疗可能导致FBGT病原菌对某些抗生素MIC升高,同时增加其形成BF的能力。     

致死性中线肉芽肿一例

致死性中线肉芽肿是一种以中线部位进行性坏死性肉芽肿为特征的少见疾病,临床表现多形性,我们于1994年10月,收治一例多次误诊误治的患者,报道如下: 患者男,34岁,1992年9月,无明显诱因左眼睑及鼻部起水肿性硬红斑,疑为血管性水肿,服强的枯30mg/d,症状一过性消退后     

致死性中线肉芽肿12例临床分析

致死性中线肉芽肿１２例临床分析陈智勇，叶庆佾，孙仁山第三军医大学西南医院皮肤科（邮政编码６３００３８）致死性中线肉芽肿（Ｌｅｔｈａｌｍｌｄｌｌｎｅｓｒａｎｄｏｍａ，ＬＭＧ）为一种以面中部出现坏死性肉芽肿为特征的少见病。现将我院１９７５～１９９３年收治...     

外伤后细菌性致死性肉芽肿

报告1例外伤后细菌性致死性肉芽肿。患者女,52岁。因鼻部外伤后进行性暗红色斑块5个月就诊。结合皮损组织病理和颅脑计算机断层扫描诊断为外伤后细菌性致死性肉芽肿。外伤后细菌性致死性肉芽肿是一种较罕见的感染性致死性疾病,对可疑患者应及早进行厌氧菌培养,提高病原菌的分离和鉴定是早期诊断该病的重要条件。     

肉芽肿性蕈样肉芽肿1例

1 病历摘要 患者男,69岁.因全身皮肤出现红斑、斑块、破溃及愈合后色素沉着16年,于2011年6月来我所就诊.16年前无明显原因患者双下肢出现暗红斑,同时膝关节内侧出现暗红色结节、溃疡,约3个月余自行愈合,留有色素沉着,后皮损缓慢蔓延至全身,无自觉症状.曾诊断"肉样瘤",未进行系统治疗.近1年来左额部及右肩背部出现暗红斑块,并破溃结痂,未愈合,自觉疼痛.     

Fatal bacteria granuloma after trauma: a new entity

In the past 20 years, more than 20 cases of a type of granulomatous disease have been noticed by dermatologists in different areas of China. The patients had these features in common: (i) the lesions followed a slight trauma to the face; (ii) they were spreading dark-red plaques without pus or ulceration; (iii) new lesions appeared near to or far from the original lesion; (iv) histopathology showed histiocytic granuloma; (v) the patients had severe headache and clouding of consciousness during the later stages of the disease; (vi) all patients died within 1.5-4 years; (vii) treatment with prednisone led to some healing of the lesions but accelerated death; and (viii) all patients were from rural areas. We examined the tissues from two similar patients by electron microscopy and identified two kinds of bacteria as a possible cause of the disease. One was an anaerobic actinomycete, the other was Staphylococcus capitis. The anaerobic actinomycete was sensitive to lincomycin (a forerunner of clindamycin). After a 5-month therapy with lincomycin, one patient survived. We infer that the cause of death is the unknown anaerobic actinomycete. Because the disease is very severe, we suggest the name 'fatal bacteria granuloma after trauma' to draw attention.     

Palisading granuloma presenting in a patient with systemic lupus erythematosus

A patient with systemic lupus erythematosus who developed a distinctive nodular eruption demonstrating typical features of palisading granuloma is presented herein. A 60-year-old woman was admitted complaining of an elastic-hard, indurated nodule on the right dorsal aspect of the metacarpophalangeal joint of her third finger with a history of several years. She was successfully treated for her lupus nephritis with oral predonisolone. She had experienced erythema on her cheeks after sun exposure and polyarthralgia for a decade. Laboratory examination revealed positive results for antinuclear antibody and rheumatoid factor. Peripheral blood cell counts showed leukocytopenia and lymphocytopenia. Results of hand X-ray were unremarkable. Histological examination of the skin biopsy specimen from the nodule revealed a structure composed of a central area of fibrinoid necrosis, surrounded by a middle zone of palisading cells and an outer zone of chronic lymphocyte infiltrate. These findings led us to the histological diagnosis of palisading granuloma. She was diagnosed as having systemic lupus erythematosus complicated with a rheumatoid nodule. She is currently under treatment with cyclophosphamide (50 mg/day) without exaggeration of her systemic lupus erythematosus and nodule.     

Subcutaneous granuloma annulare following influenza vaccination in a patient with diabetes mellitus

An influenza vaccination often causes local reactions, such as induration and erythema at the injection site, and occasionally systemic reactions. The association between these reactions and influenza vaccinations has not been fully recognized. By contrast, granuloma annulare (GA) is an idiopathic, palisaded, granulomatous condition, and has some clinical variants, including localized, generalized, perforating, and subcutaneous types. We report a 76-year-old woman, who was suffering from a tender subcutaneous nodule on her left upper arm. One month before, she had just received influenza vaccination on the same area. Histological analysis demonstrated that subcutaneous tissue contained numerous large areas of necrosis, surrounded by palisaded epithelioid histiocytes. We diagnosed our case as a subcutaneous type of GA following influenza vaccination. To our knowledge, this is the first report of GA associated with influenza vaccination.     

Majocchi's granuloma of the face in an immunocompetent patient

Majocchi's granuloma is a condition with chronic erythematous and indurated plaques that is a result of the rupture of a dermatophyte-infected infundibulum as a result of trauma. It is frequently seen on the anterior aspect of the legs of women. Herein, we present a case of Majocchi's granuloma of face, a site rarely involved, in an immunocompetent patient. Diagnosis was confirmed by histological and mycological examination. Histological examination revealed hyphae and arthrospores in the hair follicles and in the dermis with a diffuse dermal infiltrate consisting of lymphoplasmacytic cells, and focal collections of epithelioid cells, neutrophils and mild interstitial edema. Mycological examination confirmed the presence of fungus, Trichophyton rubrum, and the diagnosis of Majocchi's granuloma of the face was made. No concrete predisposing factor was found to be associated with the occurrence of the lesions on the face. However, the history of prolonged veiling of the face by a cloth by the patient, perhaps contributing to the occurrence of lesions on face, is a point of dubious significance.     

Concomitant occurrence of patch granuloma annulare and classical granuloma annulare

Granuloma annulare (GA) is characterized clinically as annularly-distributed, erythematous papules on the extremities in children and adolescents. GA is recognized histologically as palisading granulomas with central degenerated collagen and mucin deposits. Here, we present a case of concomitant occurrence of patch GA (PGA), the most rare type of GA, and classical GA in a patient. A 60-year-old man was referred to our hospital for asymptomatic eruptions on the upper arms, forearms, right flank and right lateral chest. Clinical examination revealed annular erythematous plaques composed of numerous small papules on bilateral upper arms and forearms. Moreover, an indurative, exudative erythematous to violaceous plaque was present on the right lateral chest and right flank. Histopathology of the former was compatible with palisade-type GA, and the latter interstitial-type GA. This is the first report of PGA concomitant with "classical" annular papular lesions.